Introduction of New Laryngeal Closure Methods for Patients with Intractable Aspiration

The aging population in Japan has recently resulted in a rapid increase in elderly individuals. Airway management is thus being required more and more often. Aspiration pneumonia is a life-threatening problem among patients with swallowing problems. Several new surgical methods of laryngeal closure that are easier and safer than previous methods have been developed. Among these new methods, we have performed the Kano method as closure of the larynx using double flaps of the divided craniad vocal folds and the divided caudad vocal folds with partial resection of the thyroid and cricoid cartilages for patients with intractable aspiration. We encountered minor leakage in two patients, but these soon closed spontaneously. This procedure is less invasive than other methods such as total laryngectomy and tracheal separation and has great advantages in terms of low blood loss and short duration of the operation.

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Triple-layer laryngeal closure for intractable aspiration

The Journal of Laryngology & Otology ◽

10.1258/0022215054352171 ◽

2005 ◽

Vol 119 (7) ◽

pp. 564-566 ◽

Cited By ~ 3

Author(s):

Guven Mehmet ◽

Aladag Ibrahim ◽

Eyibilen Ahmet ◽

Kaplan Yuksel

Keyword(s):

Type Ii Diabetes Mellitus ◽

Modified Technique ◽

Protective Function ◽

Laryngeal Closure ◽

Triple Layer ◽

Successful Case ◽

Closure Operations ◽

Life Threatening ◽

Intractable Aspiration ◽

Surgical Operations

Impaired laryngeal protective function can result in intractable aspiration, which causes recurrent life-threatening pneumonia. Several surgical operations have been developed to treat intractable aspiration. In this case, we report a successful case of triple-layer laryngeal closure, which was performed in a patient with type II diabetes mellitus and nutritional failure due to intractable aspiration that had been caused by several stroke attacks. Triple-layer laryngeal closure is a unique modified technique that combines laryngotracheal separation and glottic closure operations. The method that we performed can be done more safely in patients who have higher post-operative and general anaesthesia risks.

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The Evolution of Lead Extraction

European Cardiology Review ◽

10.15420/ecr.2009.5.1.32 ◽

2009 ◽

Vol 5 (1) ◽

pp. 32

Author(s):

Melanie Maytin ◽

Laurence M Epstein ◽

◽

Keyword(s):

Natural Selection ◽

Lead Extraction ◽

Significant Morbidity ◽

Extraction Techniques ◽

Extraction Technology ◽

Device Management ◽

Future Developments ◽

The Past ◽

New Methods ◽

Life Threatening

Prior to the introduction of successful intravascular countertraction techniques, options for lead extraction were limited and dedicated tools were non-existent. The significant morbidity and mortality associated with these early extraction techniques limited their application to life-threatening situations such as infection and sepsis. The past 30 years have witnessed significant advances in lead extraction technology, resulting in safer and more efficacious techniques and tools. This evolution occurred out of necessity, similar to the pressure of natural selection weeding out the ineffective and highly morbid techniques while fostering the development of safe, successful and more simple methods. Future developments in lead extraction are likely to focus on new tools that will allow us to provide comprehensive device management and the design of new leads conceived to facilitate future extraction. With the development of these new methods and novel tools, the technique of lead extraction will continue to require operators that are well versed in several methods of extraction. Garnering new skills while remembering the lessons of the past will enable extraction technologies to advance without repeating previous mistakes.

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Evaluation of mid-term results of bipolar transurethral resection in the treatment of benign prostatic hyperplasia

World Ecology Journal ◽

10.25726/nm.2019.77.26.001 ◽

2018 ◽

pp. 1-9

Author(s):

А.С. Векильян

Keyword(s):

Surgical Treatment ◽

Benign Prostatic Hyperplasia ◽

Blood Loss ◽

Endoscopic Surgery ◽

Transurethral Resection ◽

Operating Time ◽

Clinical Results ◽

Massive Bleeding ◽

Prostatic Hyperplasia ◽

Surgical Methods

Представлены клинические результаты хирургического лечения доброкачественной гиперплазии предстательной железы (ДГПЖ) объемом до 100 см3 методом биполярной трансуретральной резекции простаты (БТУР -74 пациента) в сравнении с открытой чреспузырной простатэктомией (ОПЭ - 96 пациентов), ранее применявшейся для подобных клинических случаев в урологической клинике "Железнодорожной больницы" г. Волгоград. При статистически равном операционном времени обоих хирургических методов для БТУР отмечено существенное снижение интраоперационной кровопотери, сроков послеоперационной катетеризации и пребывания в стационаре, минимальная частота геморрагических и инфекционно-воспалительных осложнений. Наблюдение за урологическим статусом пациентов в течение первого послеоперационного года показало одинаковую клиническую эффективность сравниваемых хирургических методов. Значительное снижение объема кровопотери в ходе операции БТУР можно считать большим достижением, поскольку улучшение видимости в зоне хирургического вмешательства позволяет оптимизировать гемостаз, предотвратить массивные кровотечения как во время, так и после операции, сократить сроки послеоперационной катетеризации мочевого пузыря, что в свою очередь, снижает частоту развития инфекционно-воспалительных осложнений. Более быстрое восстановление пациентов после эндоскопических операций имеет медико-социальное и экономическое значение, поскольку минимальное количество послеоперационных осложнений и сокращение сроков госпитализации позволяет существенно снизить затраты на лечение и быстрее нормализовать качество жизни пациентов. Полученные результаты демонстрируют перспективность внедрения биполярных методов эндоскопических операций для лечения ДГПЖ в хирургическую практику урологических стационаров в целях повышения безопасности оперативного лечения и экономии затрат на госпитализацию. The clinical results of surgical treatment of benign prostatic hyperplasia (BPH) up to 100 cm3 by bipolar transurethral resection of the prostate (BTUR - 74 patients) in comparison with open transvesical prostatectomy (OPE - 96 patients), previously used for such clinical cases in the urological clinic "Railway hospital" in Volgograd are presented. With statistically equal operating time of both surgical methods, there was a significant decrease in intraoperative blood loss, the terms of postoperative catheterization and hospital stay, the minimum frequency of hemorrhagic and infectious-inflammatory complications. Observation of the urological status of patients during the first postoperative year showed the same clinical efficacy of the compared surgical methods. A significant reduction in the volume of blood loss during the operation, can be considered a great achievement, since the improvement of visibility in the area of surgical intervention allows to optimize the hemostasis, to prevent massive bleeding during and after surgery, to reduce the duration of postoperative bladder catheterization, which, in turn, reduces the incidence of infectious-inflammatory complications. Faster recovery of patients after endoscopic surgery of medical,social and economic importance, as the minimum number of postoperative complications and reduction of hospitalization can significantly reduce the cost of treatment and quickly normalize the quality of life of patients. The results demonstrate the prospects of the introduction of bipolar methods of endoscopic surgery for the treatment of BPH in the surgical practice of urological hospitals in order to improve the safety of surgical treatment and save costs for hospitalization.

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The Pathophysiology and Management of Hemorrhagic Shock in the Polytrauma Patient

Journal of Clinical Medicine ◽

10.3390/jcm10204793 ◽

2021 ◽

Vol 10 (20) ◽

pp. 4793

Author(s):

Alison Fecher ◽

Anthony Stimpson ◽

Lisa Ferrigno ◽

Timothy H. Pohlman

Keyword(s):

Blood Loss ◽

Whole Blood ◽

Damage Control ◽

Clinical Information ◽

Fresh Frozen Plasma ◽

Practical Reasons ◽

Freeze Dried ◽

Life Threatening ◽

Sudden Decrease ◽

Polytrauma Patient

The recognition and management of life-threatening hemorrhage in the polytrauma patient poses several challenges to prehospital rescue personnel and hospital providers. First, identification of acute blood loss and the magnitude of lost volume after torso injury may not be readily apparent in the field. Because of the expression of highly effective physiological mechanisms that compensate for a sudden decrease in circulatory volume, a polytrauma patient with a significant blood loss may appear normal during examination by first responders. Consequently, for every polytrauma victim with a significant mechanism of injury we assume substantial blood loss has occurred and life-threatening hemorrhage is progressing until we can prove the contrary. Second, a decision to begin damage control resuscitation (DCR), a costly, highly complex, and potentially dangerous intervention must often be reached with little time and without sufficient clinical information about the intended recipient. Whether to begin DCR in the prehospital phase remains controversial. Furthermore, DCR executed imperfectly has the potential to worsen serious derangements including acidosis, coagulopathy, and profound homeostatic imbalances that DCR is designed to correct. Additionally, transfusion of large amounts of homologous blood during DCR potentially disrupts immune and inflammatory systems, which may induce severe systemic autoinflammatory disease in the aftermath of DCR. Third, controversy remains over the composition of components that are transfused during DCR. For practical reasons, unmatched liquid plasma or freeze-dried plasma is transfused now more commonly than ABO-matched fresh frozen plasma. Low-titer type O whole blood may prove safer than red cell components, although maintaining an inventory of whole blood for possible massive transfusion during DCR creates significant challenges for blood banks. Lastly, as the primary principle of management of life-threatening hemorrhage is surgical or angiographic control of bleeding, DCR must not eclipse these definitive interventions.

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Surgical treatment of patients with sagittal imbalance of degenerative etiology: a comparison of two methods

N.N. Priorov Journal of Traumatology and Orthopedics ◽

10.17816/vto202027316-26 ◽

2020 ◽

Vol 27 (3) ◽

pp. 16-26

Author(s):

Evgenii S. Baykov ◽

Alexey V. Peleganchuk ◽

Abdugafur J. Sanginov ◽

Olga N. Leonova ◽

Aleksandr V. Krutko

Keyword(s):

Surgical Treatment ◽

Blood Loss ◽

Perioperative Complications ◽

Sagittal Imbalance ◽

Radiological Parameters ◽

Results Of Treatment ◽

Group I ◽

Surgical Methods ◽

Group Ii ◽

Clinical And Radiological Results

Purpose. Compare the clinical and radiological results of treatment of patients with spinal deformities operated on using the PSO method and corrective fusion in the lumbar spine. Materials and methods. Retrospective monocenter cohort study. The data of 42 patients were analyzed. PSO (group I) was performed in 12 patients; 30 patients had a combination of surgical methods (group II) with mandatory ventral corrective spinal fusion at levels L4-L5, L5-S1. Clinical and radiological parameters were evaluated during hospitalization and at least 1 year later. Results. Postoperative hospitalization in group I 32.5 7.4 days, 27.1 7.4 in group II (p = 0.558758). The duration of the operation in group I was 402.5 55.6 minutes, in group II 526.0 116.2 minutes (p = 0.001124); blood loss 1862.5 454.3 ml versus 1096.0 543.3 ml (p = 0.000171). In both groups, significantly improved clinical and radiological parameters after surgery and after 1 year (p 0.05). In group II, as compared with group I after surgery and more than 1 year: lower back pain according to VAS (p = 0.015424 and p = 0.015424); below ODI after 1 year was (p = 0.000001). In group I, compared with group II after surgery and after 1 year, SVA is less (p = 0.029879 and p = 0.000014), lumbar lordosis is higher (p = 0.045002 and p = 0.024120), LDI is restored more optimally (p = 0.000001 and p = 0.000002), the GAP is lower (p = 0.005845 and p = 0.002639). The ideal Russoly type is restored more often in patients of group II (p = 0,00032). Complications in group I were noted in 12 (100%) patients, in group II in 13 (43.3%) patients (p = 0.001). Conclusions. In multistep surgical treatment compared with PSO, the anterior corrective interbody fusion L4-L5, L5-S1 reliably better and more harmoniously restores the sagittal balance parameters, has significantly lower volume of intraoperative blood loss, fewer perioperative complications and significantly improves the quality of life of patients.

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New Methods to Lessen Blood Loss in TKA

Techniques in Knee Surgery ◽

10.1097/btk.0b013e3182386ec0 ◽

2011 ◽

Vol 10 (4) ◽

pp. 198-205 ◽

Cited By ~ 1

Author(s):

Michael R. Fraser ◽

Denis Nam ◽

Mark P. Figgie

Keyword(s):

Blood Loss ◽

New Methods

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Challenges faced by patients, relatives and clinicians in end-stage dementia decision-making: a qualitative study of swallowing problems

Journal of Medical Ethics ◽

10.1136/medethics-2020-106222 ◽

2020 ◽

pp. medethics-2020-106222

Author(s):

Joseph Dimech ◽

Emmanuel Agius ◽

Julian C Hughes ◽

Paul Bartolo

Keyword(s):

Decision Making ◽

End Of Life ◽

Ethical Issues ◽

Tube Feeding ◽

Care Plan ◽

Term Care ◽

Swallowing Problems ◽

Swallowing Difficulties ◽

Life Threatening ◽

End Stage

BackgroundDecision-making in end-stage dementia (ESD) is a complex process involving medical, social, legal and ethical issues. In ESD, the person suffers from severe cognitive problems leading to a loss of capacity to decide matters regarding health and end-of-life issues. The decisional responsibility is usually passed to clinicians and relatives who can face significant difficulty in making moral decisions, particularly in the presence of life-threatening swallowing problems.AimThis study aimed to understand the decision-making processes of clinical teams and relatives in addressing life-threatening swallowing difficulties in ESD in long-term care in Malta.MethodThe study followed a qualitative approach where six case studies, involving six different teams and relatives of six different patients, were interviewed retrospectively to understand their decision-making in connection with the management of swallowing difficulties in ESD. Data were collected through semistructured interviews with each stakeholder. All data were transcribed and subjected to thematic analysis.ResultsFour themes were identified: the vulnerability of patients in dementia decision-making; the difficult role of relatives in decision-making; the decisional conflict between aggressive care through tube feeding versus oral comfort feeding; a consensus-building decision-making process as ideal to facilitate agreement and respect for patient’s dignity.ConclusionDecision-making to manage swallowing difficulties in ESD is a challenging process, which involves an interpretation of personal values, beliefs, patient preferences, care needs and clinical practice. Better communication between clinicians and relatives in dementia helps promote agreement between stakeholders leading to a care plan that respects the dignity of patients at their end of life.

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Blastomycosis of the Vocal folds with Life-Threatening upper Airway Obstruction: A Case Report

Ear Nose & Throat Journal ◽

10.1177/014556130208101216 ◽

2002 ◽

Vol 81 (12) ◽

pp. 852-855 ◽

Cited By ~ 12

Author(s):

Celso T. Ebeo ◽

Kenneth Olive ◽

Ryland P. Byrd ◽

Girish Mirle ◽

Thomas M. Roy ◽

...

Keyword(s):

Lower Respiratory Tract ◽

Pulmonary Infection ◽

Upper Airway ◽

Vocal Folds ◽

The United States ◽

Inappropriate Therapy ◽

Airway Compromise ◽

Inflammatory Phase ◽

Life Threatening ◽

Laryngeal Involvement

Blastomycosis is a chronic fungal disease that primarily affects the lower respiratory tract. The acute inflammatory phase of the primary pulmonary infection is characterized by a lymphohematogenous spread to extrapulmonary sites, especially the skin. The presence of disseminated infection with Blastomyces dermatitidis in the larynx is unusual. In areas of the United States where this fungus is endemic, failure to consider laryngeal involvement might lead to inappropriate therapy and thus worsening inflammation and airway compromise.

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Study on Maternal and Immediate Fetal outcome of placenta previa

Nepal Journal of Obstetrics and Gynaecology ◽

10.3126/njog.v11i2.17456 ◽

2017 ◽

Vol 11 (2) ◽

pp. 24-27

Author(s):

Sushma Lama ◽

S Ranjit

Keyword(s):

Blood Loss ◽

Medical Records ◽

Placenta Previa ◽

Fetal Outcome ◽

Intrauterine Fetal Death ◽

Dilatation And Curettage ◽

Life Threatening ◽

Study Population ◽

Risks Factors ◽

Caesarean Hysterectomy

Aims: This study aimed to analyze the demographic profile, maternal and fetal outcome of placenta previa.Methods: This was a retrospective study done at Patan Academy of Health Sciences. The study population comprised of all the patients that had caesarean section for placenta previa from April 2012 to October 2015. All patients diagnosed with placenta previa clinically, ultrasonograph or incidentally during caesarean sections were recruited in this study. The data were obtained from medical records and hospital database system. Individual charts were reviewed and data on various parameters were collected.Results: In Patan hospital, there were total 126 placenta previa cases out of 21,552 deliveries during the two and half year period hence the incidence was 0.58 %. We were able to retrieve patient records of only 108 of 126 cases. The incidence of placenta previa was higher with increasing maternal age ≥30 years (41.67%), more common in multigravida (65.74%). We found that associated risks factors included previous CS, multiparity and dilatation and curettage (40.74%). Eleven patients required blood transfusion, seven of them had blood loss of 1000-1400 ml, one had blood loss of 2000 ml. Also, Caesarean hysterectomy were performed in two patients. In term of fetal outcomes, 37.04% were preterm birth and 29.63% of the babies had low birth weight. There was one incident of congenital anomaly, one intrauterine fetal death and six neonatal deaths.Conclusions: Placenta previa is an obstetrics complication that is potentially life threatening to both the mother and the baby.

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